AB0675 AVASCULAR NECROSIS IN A COHORT OF SLE PATIENTS IN AN AFRICAN CONTEXT
Authors: S. Ntshalintshali, R. Du Toit, F. Moosajee, S. Vlok
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> There is lack of recent data in South Africa describing the burden of AVN among SLE patients. Joint replacement in South Africa remains a challenge with more than 500 days of delay in some cases hence identification of potential clinical associations for AVN development among SLE patients is an important undertaking for prevention, early detection and treatment. <h3>Objectives:</h3> 1.To determine the current prevalence of AVN among SLE patients at Tygerberg Hospital. 2.To determine associations between the development of AVN in SLE patients and SLE related factors, complications, treatment and other comorbidities. 3.To assess the outcomes of AVN in SLE patients. <h3>Methods</h3> This was a retrospective case-control study. All SLE patients (N=755) seen at Tygerberg Hospital, Rheumatology Clinic over a 8 years period (2013 – 2020) were screened for inclusion. The inclusion criteria consisted an age of 18 years with a proven diagnosis of SLE using the 2019 EULAR/ACR classification criteria, and a radiological diagnosis of AVN. The clinical data, radiological data and blood investigation data were collected for analysis. The radiological data (x-rays, MRI and CT scans) were reviewed by a radiologist for the diagnosis and grading of AVN using the Ficat and Arlet method. <h3>Results</h3> The prevalence of AVN among the SLE population at Tygerberg Hospital was 3.4%. The median SLEDAI-2K score six months prior to the radiological diagnosis of AVN (p &lt; 0.001) and the SDI (p &lt; 0.001) scores were individually found to be statistically significant between the two groups. The MRI Ficat and Arlet grading (p= 0.013) was found to be more advanced when compared with x-ray grading of the same joints, although done at different points in time with a median delay of 2 months (IQR:1-5). Only 26.3% of affected joints underwent a joint replacement with a median delay of 23 months (IQR:13-52). <h3>Conclusion</h3> The prevalence of AVN among SLE patients at Tygerberg Hospital is slightly lower than the international and the previously reported local data. High SLEDAI-2K and SDI scores were associated with AVN development in SLE. The delay in the acquisition of MRI scan for AVN diagnosis and grading, and that of joint replacement remain as significant challenges that require special attention in the state healthcare sector. <h3>References</h3> [1]Nevskaya T, Gamble M, Pope J. A meta-analysis of avascular necrosis in Systemic Lupus Eruthematosus: Prevalence and Risk Factors. Clin Exp Rheumatol. Jul-Aug 2017;35(4):700-710. [2]Ghazali WSW, Daud SMM, Mohammed N et al. SLICC damage index score in systemic lupus erythematosus patients and its associated factors. Medicine. 2018;97:42 [3]Shaharir SS, Chua SH, Mohd R et al. Risk factors for symptomatic Avascular Necrosis (AVN) in a multi-ethnic Systemic Lupus Erythematosus (SLE) cohort. PLoS ONE. 2021, 16, e0248845. [4]Kallas R, Li J, Petri M. Predictors of osteonecrosis in systemic lupus erythematosus: A prospective cohort study. Arthritis Care Res. 2020. published online ahead of print. [5]Hussein S, Suitner M, Béland-Bonenfant S et al. Monitoring of Osteonecrosis in Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis. J. Rheumatol. 2018, 45, 1462–1476. [6]Zhang K, Zheng Y, Jia J et al. Systemic lupus erythematosus patients with high disease activity are associated with accelerated incidence of osteonecrosis: A systematic review and meta-analysis. Clin Rheumatol. 2018, 37, 5–11. [7]Zangger P, Gladman DD, Urowitz MB et al. Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus. J Rheumatol. 2000 Apr;27(4):919-923. [8]Guo P, Gao F, Wang Y et al. The use of anticoagulants for prevention and treatment of osteonecrosis of femoral head. Medicine (Baltimore). 2017 Apr; 96(16): e6646. [9]Stoica Z, Dumitrescu D, Popescu M et al. Imaging of avascular necrosis of femoral head: Familiar methods and newer trends. Curr Health Sci J. 2009 Jan-Mar; 35(1): 23–28. [10]Kumar Sen R. Management of avascular necrosis of femoral head at pre-collapse stage. Indian J Orthop. 2009 Jan-Mar;43(1):6-16. <h3>Acknowledgements</h3> I would like to thank the Rheumatology unit at Tygerberg Hospital for assisting with patient identification and data collection. A special recognition to Prof Riette du Toit, Dr Sucari Vlok, Dr Farzana Moosajee and Dr Lisa du Plessis. <h3>Disclosure of Interests</h3> None declared